Endoscopic-Assisted Crestal Sinus Lift: Safer but More Time- and Cost-Intensive: Study
A recent study published in the International Journal of Implant Dentistry revealed that endoscopic-assisted crestal sinus lifting improves membrane visualization, enhances safety and predictability, and reduces perforation risk, but requires longer surgical time and higher cost.
The participants were randomly assigned to one of two treatment groups. The first group underwent a traditional crestal approach, while the second group received an endoscopic-assisted crestal approach, in which a 2.7 mm rigid endoscope was employed to visually monitor the Schneiderian membrane and ensure its integrity with each surgical step. After careful elevation, both groups received bone graft material consisting of a xenograft combined with platelet-rich fibrin (PRF), followed by the placement of dental implants.
A total of 22 implants were inserted, 11 in each group. Membrane perforation, one of the most common and concerning complications in sinus-lift procedures, occurred in 33% of patients treated with the conventional approach, when compared to only 10% in those who underwent the endoscope-assisted surgery. Although this reduction was notable, the p-value of 0.582 indicates that statistical significance was not achieved, likely due to the small sample size. Yet, the trend suggests a clinically meaningful improvement in safety when visualization tools are used.
However, the enhanced precision came with a trade-off: surgical time increased significantly. The procedures performed with endoscopic assistance averaged 27.3 minutes, when compared to 15.4 minutes for the conventional method, which represents nearly double the operating duration. This difference was highly significant (p < 0.0001), highlighting a key consideration for clinical decision-making and patient scheduling.
In addition to complication rates and time expenditure, this research analyzed changes in bone density surrounding the implants. Measured in Hounsfield Units, bone density improved steadily over six months, rising from approximately 609 HU immediately following surgery to 878 HU, indicating successful graft maturation and improved implant stability. These results demonstrate that both surgical methods support long-term bone quality enhancement, regardless of visualization technique.
Overall, the findings of this study revealed that endoscopic-assisted crestal sinus lifting offers a unique advantage by enabling direct real-time assessment of membrane integrity, thereby increasing surgical predictability and reducing the likelihood of perforation. Yet they stressed the need to consider higher costs, longer procedure times, and learning-curve demands before adopting the method widely.
Source:
Elian, S., Abdelfattah, A., & Baiomy, A. (2025). Conventional versus endoscopic-assisted crestal sinus lifting with simultaneous implant placement: a comparative clinical study. International Journal of Implant Dentistry, 11(1), 67. https://doi.org/10.1186/s40729-025-00653-3
